Provider Demographics
NPI:1629077466
Name:ROSS, STEVEN L (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 HILLTOP DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5894
Mailing Address - Country:US
Mailing Address - Phone:817-598-0784
Mailing Address - Fax:817-598-0788
Practice Address - Street 1:975 HILLTOP DR STE 200
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5894
Practice Address - Country:US
Practice Address - Phone:817-598-0784
Practice Address - Fax:817-598-0788
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4387541OtherAETNA PROVIDER NUMBER
TX00F35ROtherBLUE CROSS ID
TX1336208-01Medicaid
TX133620801Medicaid